Inspection on 28/06/05 for David Lewis Centre Adult Assessment Unit

This inspection was carried out on 28th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

David Lewis Centre Adult... 05/03/07

David Lewis Centre Adult... 06/03/06

David Lewis Centre Adult... 03/02/05

David Lewis Centre Adult... 16/06/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 David Lewis Centre Adult Assessment Unit Mill Lane Warford Alderley Edge SK9 7UD Lead Inspector Helena Dennett Announced 28 June 2005 09:30 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. David Lewis Centre Adult Assessment Unit F51 F01 S18800 DLC Adult Assessment Unit V227839 280605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service David Lewis Centre Adult Assessment Unit Address Mill Lane Warford Alderley Edge Cheshire SK9 7UD 01565 640000 01565 640100 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) David Lewis Organisation Miss Lynn Sharrock Care Home 9 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (9) of places Physical Disability (1) Learning Disability (9) David Lewis Centre Adult Assessment Unit F51 F01 S18800 DLC Adult Assessment Unit V227839 280605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1 This service is registered for 9 service users who suffer from seizure disorders to include: · Up to 9 service users in the category of MD (mental disorder excluding learning disability or dementia). · Up to 9 service users in the category of LD (learning disability). · Up to 1 service users in the category of PD (physical disability). 2 The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The registered manager must obtain a nationally recognised qualification, at Level 4 NVQ or equivalent, in management before 1st April 2005. Service users accommodated for short stay periods must be 18 years and above. 3 4 Date of last inspection 3rd February 2005 Brief Description of the Service: The David Lewis centre is set in 170 acres of land and has a village atmosphere . The centres drives are tree lined and there are extensive wellmaintained garden gardens and playing fields. There is a swimming pool, gymnasium, workshops and a social club. There is also a school and college on the site. The grounds are pleasant and well cared for. The adult assessment unit is a nine-bedded unit. The purpose of the unit is to proved an informal environment for the detailed assessment of adults with complex epilepsy and other associated problems. The unit has nine single rooms including one suitable for diasabled persons and two video telemetry rooms. David Lewis Centre Adult Assessment Unit F51 F01 S18800 DLC Adult Assessment Unit V227839 280605 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of the adult assessment unit is to provide an informal environment for the detailed assessment of adults with complex epilepsy and other associated problems. Video – Telemetry is used. This involves staying in a specificially equipped room (usually overnight) whilst the video records the patients activities and the EEG records brain activity. Due to the nature of the treatment and the fact that patients stay between two and six weeks, some of the national minimum standards are not applicable to this unit. The inspection took place over 5.25 hours. There were eight patients resident within the unit. Four patients were spoken to during the course of the inspection. Two comment cards were received back, one from a care manager and one from a relative/visitor. These were very positive about the service on offer. The people spoken with referred to themselves and others on the unit as ‘patients’. Therefore this term is used throughout the report. What the service does well: The unit is well managed and run. Patients are well informed on their treatment and what to expect before being admitted to the unit. Good relationships appear to exist between staff, patients and consultants. Patients can choose where they sit, eat and the activities they take part in. Visitors are made welcome, residents’ relatives are kept well informed Care plans were well written and provided enough information so that staff know what to do to meet the residents’ needs. Most of the staff have worked on the unit for some time and know the patients well. Staff were seen to work well with the patients and the atmosphere in the unit is cheerful and friendly. Nursing staff are knowledgeable about epilepsy and associated conditions. David Lewis Centre Adult Assessment Unit F51 F01 S18800 DLC Adult Assessment Unit V227839 280605 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. David Lewis Centre Adult Assessment Unit F51 F01 S18800 DLC Adult Assessment Unit V227839 280605 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection David Lewis Centre Adult Assessment Unit F51 F01 S18800 DLC Adult Assessment Unit V227839 280605 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 & 3 Although it is not always possible for staff from the unit to visit patients before admission, an assessment by healthcare professionals is always completed before referral to the unit so that patients needs can be met when admitted. EVIDENCE: Patients are admitted for assessment from various parts of the country. The unit accepts referrals from consultants. Where possible the unit staff try to visit patients in their own homes before admission. Every patient is given a contract to sign on admission. The contract sets out in detail the treatment to be provided to the patient and the length of time they are expected to stay on the unit. David Lewis Centre Adult Assessment Unit F51 F01 S18800 DLC Adult Assessment Unit V227839 280605 Stage 4.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8 &9 The care plans include information on all patients care needs and how these are to be met so they are safe and well at all times. Although there may be restrictions placed on patients movements during the assessment process these are discussed with them first so that they know what to expect during their stay on the unit. All records are kept securely. EVIDENCE: Patients spoken to were very positive about the care and treatment they receive on the unit. They said they are consulted on the treatment and can make decisions about their lives. Each patient has an individual plan of care which includes all the information necessary for staff to make sure that their needs are met . The plan of care is revised regularly and changed as necessary. David Lewis Centre Adult Assessment Unit F51 F01 S18800 DLC Adult Assessment Unit V227839 280605 Stage 4.doc Version 1.40 Page 10 Due to the type of treatment provided on the unit, some restrictions may be placed on patients movements during the assessment process. Patients are informed of these restrictions and when checked were documented in the plan of care. Patients confirmed that they are consulted on their care. There were signed consent to treatment forms available in the care files. Risk assessments are available in all files. These identify any risks that may be present and the action to be taken to minimise that risk. All records are kept securely on the unit to maintain patient confidentiality. David Lewis Centre Adult Assessment Unit F51 F01 S18800 DLC Adult Assessment Unit V227839 280605 Stage 4.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15 &17 There are plenty of activities offered around the centre to meet the needs of the patients and to keep them stimulated. Within the constraints of their treatment patients can choose how they spend their time, which enables them to keep control over their lives. Although staff on the unit have tried to make sure that patients are given a choice of food as far as possible, this might not always be the case as choices have to be submitted to the kitchen one week in advance, which means some patients may not be able to choose which meal they have. EVIDENCE: There is a range of activities at the David Lewis Centre that patients can access depending on the assessment process and treatment they require. Two of the patients spoken with said that they worked at the centre during the day. One patient stated he likes to go out and about around the centre whenever he can. David Lewis Centre Adult Assessment Unit F51 F01 S18800 DLC Adult Assessment Unit V227839 280605 Stage 4.doc Version 1.40 Page 12 One patient was helping dig out the flower beds at the back of the unit. He said that he enjoyed this activity and found it kept him healthy. Patients said that they enjoyed staying on the unit and preferred it to a hospital admission as it is more homely, they could do what they wanted and that their visitors could come at any time. Video-telemetry is used as a diagnostic tool and does affect the daily life of the patient who is undergoing this type of assessment. This is agreed and consent given before the treatment starts. Mealtimes are standard on the unit, however the manager said that there were some frozen meals available for patients out and about and these can be cooked in the microwave. Patients choice of menu has to be given to the chef a week in advance. As it is a short stay unit, this system makes it difficult for individual’s to make a choice of meals they would like to have. The manager stated that they pre-order a larger number of meals so that patients can be generally given what they want. The manager also stated that a dietician is involved on site and that she was looking at the menus currently on offer to residents across the site. One patient gave the meals a 7/10 score. Two other patient’s stated that they were ‘hit and miss’. On the day of the inspection soup and sandwiches were offered for lunch. A plastic bag containing 6 éclairs were sent up for dessert, with a few bananas. There was no cream sent to have with the desert. These did not look appetising. See Requirement 1 David Lewis Centre Adult Assessment Unit F51 F01 S18800 DLC Adult Assessment Unit V227839 280605 Stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19 Patients on the unit are given the appropriate personal and healthcare support they need to make sure that their needs are met in full during their stay on the unit. EVIDENCE: All patients spoken to said that the staff on the unit were excellent. They felt their privacy and dignity and choice were maintained as far as possible within the constraints of their treatment. There was evidence in the plan of care that staff were meeting the physical and emotional needs of the patients. One patient admitted for video telemetry had the support of a carer 24 hours per day. This was identified as necessary in his plan of care. David Lewis Centre Adult Assessment Unit F51 F01 S18800 DLC Adult Assessment Unit V227839 280605 Stage 4.doc Version 1.40 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 &23 Information about the complaints process for the home is readily available so patients and their relatives know how to make complaints and who to make them to. Although there is a policy on adult protection ensuring that patients are protected from abuse, this needs to be updated, to make sure that staff have the most up to date information on the action to be taken if an allegation of abuse is made. EVIDENCE: There is a complaint policy for the centre. Information on the use of advocacy is included in the welcome pack. No complaints have been made to the CSCI since the last inspection. There is an adult protection policy in place. This needs to be updated. See Recommendation 1. David Lewis Centre Adult Assessment Unit F51 F01 S18800 DLC Adult Assessment Unit V227839 280605 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 &30 The corridors are showing signs of wear and tear and are in need of redecorating. Patients’ bedrooms are not homely. Although the main areas of the unit were found to be clean, the laundry was not clean, the microwave was dirty and the freezer required defrosting and could put patients at risk. EVIDENCE: Patients spoken to said they felt the unit was more homely that a hospital. There are signs of wear and tear throughout the building in particular the corridor areas. There is a large lounge area for patients to use and a separate dining room is available. There are plans to redecorate the lounge at Christmas. Bedrooms are not homely and are clinical in appearance. A laundry is available for residents to use. It contains a small domestic washing machine and sink. The shelves in the laundry were dusty and needed cleaning. There was no soap or paper towels available for patients or members of staffs use. The worktop was broken and in need of repair or replacement. David Lewis Centre Adult Assessment Unit F51 F01 S18800 DLC Adult Assessment Unit V227839 280605 Stage 4.doc Version 1.40 Page 16 When questioned staff said that a cleaner is allocated for one and a half hours a day to clean the unit. The microwave in the kitchen was dirty and in need of cleaning. The freezer in the kitchenette was frosted over and needed defrosting. See Requirement 2 David Lewis Centre Adult Assessment Unit F51 F01 S18800 DLC Adult Assessment Unit V227839 280605 Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34 &35 There were enough staff on duty to meet the needs of the residents. Although most staff have had training to be competent to do their jobs, several members of care staff have not had training in dealing with patients with mental health needs. EVIDENCE: Staffing levels are adequate to meet the needs of the patients. Patients were very complimentary about the staff and felt they had confidence in their ability to care for patients with epilepsy and associated conditions. An additional member of staff was present with one patient who was assessed as requiring 1:1 care. The interactions between this member of staff and the patients were seen to be very positive, a good relationship appeared to exist between them. Recruitment records were seen during the inspection. The inspector raised a concern regarding a written note in one persons file. The acting manager of the unit was unaware of the contents and said she would investigate this issue. All the relevant checks had been done on prospective employees. Although staff are offered training on a regular basis none of the care staff has attended training on mental health needs of patients. See Recommendation 2 David Lewis Centre Adult Assessment Unit F51 F01 S18800 DLC Adult Assessment Unit V227839 280605 Stage 4.doc Version 1.40 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39, 40 &42 The unit is well run, with trained staff and effective health and safety systems to ensure that patients and staff are safe. Although the views of the patients have been sought, suffiecient action has not been taken to address the problems they identified. EVIDENCE: The manager of the unit is currently on maternity leave. An acting manager has been appointed in her absence. Patients said that all the staff are approachable. Staff meetings are held regularly. There are written policies and procedures in place for the centre and the unit. A recommendation was made at the last inspection that policies should be reviewed and updated in particular the adult protection policy. This has not been done. See Recommendation A quality assurance survey has been carried out since the last inspection and patients are given questionnaires to complete. David Lewis Centre Adult Assessment Unit F51 F01 S18800 DLC Adult Assessment Unit V227839 280605 Stage 4.doc Version 1.40 Page 19 After the last inspection a food survey was undertaken. The results indicated that patients had felt that at times there was not enough food offered to them and that they did not have choice and that sometimes the food was lukewarm. Patients spoken to on the day of the inspection still had concerns regarding the food provided to them. This is an outstanding requirement from the last inspection. A policy group meets regularly and reviews all policies pertaining to the centre. However the policy on adult protection has not be reviewed or updated. A health and safety officer is employed by the centre. David Lewis Centre Adult Assessment Unit F51 F01 S18800 DLC Adult Assessment Unit V227839 280605 Stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 2 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 x 2 Standard No 31 32 33 34 35 36 Score x x x 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 David Lewis Centre Adult Assessment Unit Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score 3 2 x 3 x 3 x F51 F01 S18800 DLC Adult Assessment Unit V227839 280605 Stage 4.doc Version 1.40 Page 21 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 17 Regulation 16 Requirement Timescale for action 30/9/05 2. 30 16 The registered person must review the system to make sure that patients are given a choice of meals and that the meals served are kept at a reasonable temperature. (Timescale 30/3/05 not met) Equipment in the kitchenette and 31/7/05 the laundry area must be kept clean to prevent the risk of cross infection. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 40 35 Good Practice Recommendations Policies should be reviewed regularly and updated in particular the adult protection policy. Training on mental health should be provided to care staff. David Lewis Centre Adult Assessment Unit F51 F01 S18800 DLC Adult Assessment Unit V227839 280605 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Unit D, Off Rudheath Way Gadbrook Park Northwich Cheshire CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI David Lewis Centre Adult Assessment Unit F51 F01 S18800 DLC Adult Assessment Unit V227839 280605 Stage 4.doc Version 1.40 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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